Chapter 27: Penile Discharge Evaluation

The text distinguishes between the two primary classifications of urethritis: gonococcal urethritis, caused by Neisseria gonorrhoeae, and nongonococcal urethritis (NGU), most frequently attributed to Chlamydia trachomatis, though other pathogens like Ureaplasma urealyticum and Trichomonas may be involved. Key concepts in diagnostic reasoning are explored, emphasizing the importance of a comprehensive sexual history to identify risk factors such as new partners, unprotected intercourse, and coinfection rates. The summary details clinical presentations, noting that gonococcal infections typically present with a short incubation period and copious yellow-green discharge, whereas chlamydial infections often have a longer incubation and scant, mucoid discharge. Significant attention is given to the physical examination, including the inspection of the glans and meatus for inflammation or lesions, palpation of lymph nodes for adenopathy, and assessment of the scrotum and testicles to rule out complications like epididymitis or orchitis. The chapter outlines essential laboratory studies, such as urine dipsticks for leukocyte esterase, Gram staining to identify gram-negative intracellular diplococci (GNICDCs), and high-sensitivity molecular testing like DNA probes or nucleic acid amplification tests to confirm specific pathogens. Furthermore, the text covers critical differential diagnoses, including balanitis, acute and chronic prostatitis, and disseminated systemic infections which may present with skin lesions or reactive arthritis (Reiter syndrome). Finally, management strategies are discussed, highlighting the necessity of partner notification and expedited partner therapy to reduce reinfection rates and halt the spread of sexually transmitted infections.